Taxpayer-owned nursing home: Keep, close or convert?

What would you do with a nursing home that was losing hundreds of thousands of dollars a year? If you live in Butler County — or 32 other counties in Ohio — you own one and might struggle to keep it going.

That question has been asked several times across Ohio as local officials determine how to best use limited resources. In Muskingum County, for example, officials shuttered their facility in 2012 for financial reasons. Neighboring Perry County, however, continues to operate a home with a voter-supported tax levy.

“County homes are not mandated by law, so I think, from a responsible business perspective, there are commissioners that will take that question and apply it,” said Denise Percival, president of the Ohio County Home Association.

Percival, who runs a home owned by Greene County, said there’s no real trend of county-owned nursing homes shutting down across Ohio. However, sheer numbers show that 55 have closed since the 1970s, when state legislators no longer required counties to operate nursing homes, Butler County home administrator Chuck Demidovich said.

Butler County commissioners will ponder the possibility of converting part of its Butler County Care Facility into a detox center for heroin addicts later this month, and it’s a toss-up whether the proposal will get the OK. An approval would be the first such agreement in the state.

Commissioners T.C. Rogers and Don Dixon, however, have voiced concern about security for the home’s other 100-plus residents. They also want to make sure the county doesn’t hemorrhage money over the venture at a time when governments across the country are shutting down their homes because of the cost.

Dixon has publicly questioned why Butler County even keeps its 109-bed home open.

“As a nursing facility goes, I don’t think the county has a need to be in that business,” Dixon told The Cincinnati Enquirer.

Historically ending each year with a $200,000 to $300,000 reserve, the nursing home has been struggling since Ohio Gov. John Kasich reduced the amount of Medicaid reimbursements as part of the state budget in 2011 by $27 a patient.

“Medicaid rates are not keeping up with health insurance rates and things that cost me as a county to operate,” Demidovich said. “We take everybody that falls between the cracks, and sometimes we get paid and sometimes we don’t.”

Demidovich borrowed $375,000 from the county last year because of a deficit. An agreement to pay that back by the end of 2014 forced layoffs of 10 people, including staff that provided physical therapy to residents. That service was contracted out instead. Employees, who hadn’t had a raise in six years, also took pay cuts, he said.

Care vs. costs

The story was similar in Muskingum County just a few years ago. The facility closed at the end of July 2012 after commissioners decided it wasn’t a good use of taxpayer dollars.

Voters narrowly approved the levy that was funding the home by just 253 votes in May 2010. The building was in disrepair and was not certified for Medicaid or Medicare services. Taxpayers were facing up to $3 million in repairs alone.

“We didn’t own the building, and the building had a lot of issues with it,” Muskingum County Commissioner Jerry Lavy said.

There are two types of county homes in Ohio — those that are not and those that are certified to provide skilled nursing care, rehabilitative services and hospice care. The latter receive Medicaid and Medicare reimbursements. About half of Ohio’s 33 county homes are certified.

“It’s just a battle to try to find an affordable way to meet the needs and maintain your operation. You can only cut so much of your overhead and still be able to meet the needs of the residents,” Percival said.

Some protested the decision at the time, but discontent settled down within a few months, Lavy said. Many people supported the decision to close the home, which saved taxpayers about $2.9 million annually. It was time for Muskingum County to get out of the health care business.

“I have not heard anything for about two years,” Lavy said.

But people using the home in neighboring Perry County see it as a godsend.

With a hip injury, it took Patricia Allen, 74, about 10 minutes to walk from her living room to her kitchen just feet away. She also was unable to pay for the house’s upkeep.

“I was too poor to hold onto that home,” said Allen, who worked in a factory and lived in New Lexington. Her relatives suggested the Perry County Home.

Allen is one of 30 people who live at the Perry County Home, renamed Fairview Assisted Living in 2004 to reduce the negative stigma attached to county homes. The land was purchased in 1836 and has operated continuously for more than 150 years.

The home, which can house up to 50 people, operates as an alternative for older adults who can no longer live at home but do not require the specialized care of nursing homes, director Lillian Holman said. Residents pay $450 a month, which is subsidized by a county levy.

Perry County voters have supported the levy consistently, most recently in November 2011 when the 1-mill levy passed with 62.3 percent of the vote. The owner of a $100,000 home pays about $20.64 annually for the levy, which generates $718,412 each year for the home.

Holman understands county homes, formerly known as poor houses and county infirmaries, have negative images attached to them, but word of mouth helps Fairview Assisted Living maintain support in the community from commissioners, relatives of residents and voters.

“The county home is not your last choice, but often your best choice for your relative,” Holman said.

Ed Keister, president of the Perry County Board of Commissioners, called the home “a great asset to the community.” The facility also creates jobs by employing 26 people.

Finding new ways

Percival called Demidovich a “pioneer” for coming up with the idea to detox heroin addicts at the Butler County home.

She said other government-owned homes throughout Ohio are finding niches to provide services that are lacking in an effort to keep revenue flowing.

Demidovich approached county commissioners in July and was told there were too many concerns for commissioners to make a decision then. Butler County Sheriff Richard K. Jones also weighed in, saying it was a “100 percent bad idea” because of the security issues.

Demidovich has since revamped the plan to address the security issues by placing the detox beds in a different wing that has its own entrance. Building security would be posted by a door that opens into the rest of the nursing home, and an alarm has been installed on those doors to signal when someone tries to leave the wing, he said. Security cameras already are up.

Demidovich, who has been working with the county’s opioid task force, is expected to present the updated proposal to commissioners Monday.

“My personal belief is somebody’s got to start helping these people,” Demidovich said. “The addictive side of it is absolutely horrendous.”

History of county-owned homes

Ohio legislators passed a law in 1816 requiring counties to build and operate homes to provide care for the poor. At the time, abnormally low summer temperatures had resulted in major food shortages and sharp increases in food prices.

The homes were set up as a farm, and residents were expected to work on the farm if they were able to provide food.

First referred to as “poor houses,” the homes took on other functions depending on what was needed in a community. Some were used as infirmaries and tuberculosis clinics.

In the early 1970s, state legislators dropped the mandate for counties to operate. Since then, 55 of 88 counties have shuttered theirs.